Engin Cekin

Real-time PCR detection of Helicobacter pylori and virulence-associated cagA in nasal polyps and laryngeal disorders:

Objective: To identify Helicobacter pylori and major virulance factor, cagA, in patients with laryngeal diseases and nasal polyps. Study Design: Cross-sectional study with planned data collection. Setting: The study was performed on fresh tissue samples from patients with 32 nasal polyps, 29 normal nasal mucosa, and 27 laryngeal diseases presenting to the Otolaryngology–Head and Neck Surgery department of a major military hospital in Istanbul, Turkey. Subjects and Methods: Tissue specimens were evaluated by in-house polymerase chain reaction (PCR) and real-time PCR for bacterial DNA and by real-time PCR for cagA. The impact of commercial and in-house DNA extraction methods was also evaluated. Results: H pylori DNA was detected only by real-time PCR in 59.4 percent of nasal polyps, 70.4 percent of nasal mucosa samples, and 58.6 percent of larynx samples. cagA was identified in 78.9, 89.5, and 82.4 percent of positive polyp, nasal mucosa, and larynx samples, respectively. No statistically significant differences were observed between groups. DNA purification methods were equally effective. Conclusion: H pylori DNA is present in nasal polyp and larynx tissues as well as normal nasal mucosa, as detected by a sensitive real-time PCR assay. cagA-positive strains dominate in all groups.

Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss.

OBJECTIVE To evaluate the effectiveness of hyperbaric oxygen therapy in the management of sudden hearing loss. STUDY DESIGN Patients with sudden hearing loss were divided into study and control groups. The 36 patients in the study group were treated with hyperbaric oxygen therapy in addition to standard medical therapy, whereas the 21 patients in the control group were treated with only standard medical therapy. SUBJECTS AND METHODS Both groups were treated with standard therapy, comprising prednisolone starting at a dose of 1 mg/kg and reducing over three weeks. Patients in the study group received hyperbaric oxygen therapy in addition to standard drug therapy. RESULTS Success rates were 78.95 per cent in the study group and 71.30 per cent in the control group. However, this difference was not statistically significant (p > 0.05). CONCLUSIONS Considering the cost of hyperbaric oxygen therapy and its inconvenience to patients, this treatment should only be considered in patients suffering sudden hearing loss if there are contraindications to standard medical treatment.

The Association of Oxidative Stress and Nasal Polyposis

Many diseases are linked to damage from reactive oxygen species that occurs from an imbalance between reactive oxygen species and antioxidants, a condition called oxidative stress. Nasal polyposis is considered to be an inflammatory condition in nasal and paranasal sinus cavities and its aetiology is still unclear. There are very few data on epithelial changes in nasal polyposis and their relationship with free radical damage. Malondialdehyde as a major end-product of lipid peroxidation, and superoxide dismutase and nitric oxide as antioxidants play important roles in oxidative stress. In this study, the concentrations of malondialdehyde, superoxide dismutase and nitric oxide were compared in normal and nasal polyposis-affected tissue samples. Malondialdehyde levels were significantly higher, and superoxide dismutase and nitric oxide levels were significantly lower in patients with nasal polyposis compared with the control group. This study demonstrates that there is a strong relationship between oxidative stress and the pathogenesis of nasal polyposis.

Human papilloma virus prevalence in laryngeal squamous cell carcinoma.

PURPOSE To determine the prevalence and type of human papilloma virus deoxyribonucleic acid (DNA) in cases of laryngeal squamous cell carcinoma. METHODS We analysed the prevalence of human papilloma virus infection in archived paraffin block specimens taken from 99 cases of laryngeal squamous cell carcinoma between 1990 and 2005, using polymerase chain reaction techniques. Biopsy specimens from five proven verrucous skin lesions were used as positive controls, and peripheral blood samples from five healthy volunteers were used as negative controls. RESULTS Four test samples were found to have inadequate deoxyribonucleic acid purity and were therefore excluded from the study. Human papilloma virus deoxyribonucleic acid was detected in seven of 95 cases of laryngeal squamous cell carcinoma (7.36 per cent). Human papilloma virus genotyping revealed double human papilloma virus infection in three cases and single human papilloma virus infection in the remaining four cases. The human papilloma virus genotypes detected were 6, 11 and 16 (the latter detected in only one case). CONCLUSION In our series, a very low human papilloma virus prevalence was found among laryngeal squamous cell carcinoma cases. The human papilloma virus genotypes detected were mostly 6 and/or 11, and 16 in only one case. To the best of our knowledge, this is the first report of human papilloma virus prevalence in laryngeal squamous cell carcinoma, based on polymerase chain reaction genotyping in a Turkish population.

Effects of topical application of mitomycin-C and 5-fluorouracil on myringotomy in rats.

OBJECTIVE The effects of topical application of Mitomycin-C (MMC) and 5-fluorouracil (5-FU) for maintaining myringotomy patency were investigated in this experimental study. STUDY DESIGN We performed simple myringotomy with a knife on 140 tympanic membranes of 70 rats. Rats were divided in two study groups and a control group. Each study group had 60 tympanic membranes, and the control group had 20. We applied Mitomycin-C (0.4 mg/ml) in Group A, 5-fluorouracil (50 mg/ml) in Group B topically, and sterile saline in the control group for 10 minutes. Examination was made with otoendoscope on days 1, 3, 5, 7, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, and 70, and patency rates were recorded. RESULTS MMC and 5-FU Groups remained open for a mean of 46.17 days and 14.62 days, respectively. The control ears healed within 10.4 days. Fibrosis of the MMC-treated group was the same as that of 5-FU-treated groups. Fibrosis of both study groups was significantly lower than that of the control group. CONCLUSIONS MMC is more effective than 5-FU, which is more effective than the simple myringotomy procedure in extending the patency of myringotomies in rat tympanic membranes (p < 0.05). Both medications are useful as an adjunct in preventing myringotomy closure.

Effects of halofuginone on fibrosis formation secondary to experimentally induced subglottic trauma.

Objective: The aim of the study was to assess the antifibrotic effect of systemically applied halofuginone after subglottic injury.

Histologic effects of injection snoreplasty and radiofrequency in the rat soft palate.

OBJECTIVE: This study was undertaken to compare the effects of radiofrequency and injection snoreplasty on the histological structure of the soft palate in an animal model. STUDY DESIGN AND SETTING: This is a blinded, controlled histologic evaluation of rat soft palates that underwent separate palatal interventions. Fifty rats were divided into 5 groups of 10 rats (Group 1 = injection snoreplasty [IS], Group 2 = IS + steroid, Group 3 = saline injection, Group 4 = radiofrequency ablation [RFA], and Group 5 = no intervention). The animals were sacrificed after 24 hours, 1 week, 3 weeks, and 5 weeks. Then the soft palates were subjected to histological analysis. RESULTS: Histological analysis demonstrated normal remucosalization in all specimens, with fibrosis increased in Group 1. Interstitial edema was minimal in Group 2. Keratinization was most apparent in Group 4. CONCLUSION: Radiofrequency and injection snoreplasty stiffen the rat soft palate compared with controls.

The effects of systemic, topical, and intralesional steroid treatments on apoptosis level of nasal polyps.

Objective The purpose of this study was to compare the apoptotic responses to systemic, topical, and intrapolyp injection of glucocorticoid with no treatment in nasal polyps. Study Design Prospective, randomized controlled study. Setting Tertiary training hospital. Subjects and Methods The study was performed on 48 patients with nasal polyposis in the Department of Otorhinolaryngology between 2008 and 2009. Patients were assigned to 1 of 4 groups of 12 patients. Group A was treated with oral methylprednisolone 1 mg/kg/d, and the dose was tapered gradually. Group B received 0.3 mL triamcinolone acetonide (40 mg/mL), which was injected into polyp tissue. Group C was treated with topical 55 µg triamcinolone acetonide 2 times daily for 1 month. Group D received no medication. Samples were collected endoscopically after the seventh day for groups A and B, the first month for group C, and the first visit for group D. Apoptotic indexes were determined using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method. Results Statistically significant differences in apoptotic index were found between each steroid-medicated group and the control group (PD-A = .0001; PD-B = .003; PD-C = .026) and between groups A and C (PA-C = .012). Group B did not differ significantly from either group A or C (PA-B = .11; PB-C = .75). Conclusions The apoptotic index in nasal polyps treated with systemic, topical, and intrapolyp injection forms of glucocorticoids was higher than that in the control group. Systemic steroid treatment induced the most apoptosis.

Peripheral osteoma of the mandible mimicking a parotid mass

We report the case of a peripheral osteoma mimicking a benign tumor in the left parotid gland of a 75-year-old woman. The clinical presentation of the painless mass on the lateral surface of the mandibular ascending ramus was suggestive of a benign parotid tumor such as a pleomorphic adenoma. It was diagnosed using computed tomography (CT) and further delineated using 3D spiral CT scanning. Mandibular osteoma should be considered in differential diagnosis of parotid masses, which can be revealed by conventional radiographs.

Comparison of Uvulopalatopharyngoplasty, Laser-Assisted Uvulopalatoplasty and Cautery-Assisted Uvulopalatoplasty in the Treatment of Primary Snoring

Objective: Our aim was to compare the postoperative pain and surgical results of uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP), and cautery-assisted uvulopalatoplasty (CAUP) procedures in the treatment of primary snoring. Methods: 54 patients were stratified according to a modified Friedman staging system (MFSS) for sleep-disordered breathing. Tonsil size (1, 2, 3) and palatal position scale (grade 1–2) and body mass index <30 according to the MFSS were included for standardization. Three workgroups consisting of 18 patients each were formed and UPPP, LAUP and CAUP procedures were performed. The success of the surgical procedures was evaluated by applying the Epworth Sleepiness Scale to the patients, and the patients’ bed partners were asked to evaluate the snoring level preoperative and 45 days after the operation to determine any improvement in snoring complaints. Patients were followed for postoperative pain, secondary infection, bleeding, permanent velopharyngeal insufficiency and nasopharyngeal stenosis. Results: Snoring was relieved in 83.3% of UPPP and CAUP groups and in 88.8% of LAUP 45 days after operation. The mean pain duration was 5.71 days for the UPPP patients, 6.28 days for the LAUP patients and, 4.12 days for the CAUP patients. The mean pain score was 2.1 for the UPPP patients, 2.38 for the LAUP patients, and 1.6 for the CAUP patients. Only 1 patient was hospitalized due to pain in the LAUP group. Conclusion: The effectiveness of UPPP, LAUP and CAUP procedures were found to be similar (more than 83%). Postoperative pain was mostly seen in LAUP and UPPP cases. The CAUP procedure was easy and the least painful.